Background: Recent refinements in percutaneous techniques have resulted in an increase in the numbers of patients with diffuse coronary artery disease who are referred to cardiac surgeons. Long-segmental reconstruction of the diffusely diseased left anterior descending (LAD) coronary artery with the left internal thoracic artery (LITA) has been shown to be beneficial for patients with diffuse coronary artery disease. In this retrospective study, we analyzed the long-term outcomes obtained with this technique.
Methods: Between April 1997 and February 2006, 3736 coronary artery bypass grafting (CABG) operations were performed by our team. Of these cases, 524 patients (14%) with the diffusely diseased LAD underwent a long-segmental reconstruction procedure with a LITA graft.
Results: The cohort consisted of 372 men (71%) and 152 women (29%), and the mean age was 56.5 +/- 8.2 years. The mean length of the arteriotomy incision was 4.5 +/- 1.2 cm (range, 2 to 10 cm). Postoperative mortality was 1.9%, and the myocardial infarction rate was 6.9%. At 3, 5, and 7 years, overall survival was 93.8% +/- 0.5%, 89.6% +/- 1.5%, and 85.5% +/- 2.6%, and actuarial freedom from angina recurrence was 94.5% +/- 1%, 88.5% +/- 2%, and 82.9% +/- 3%, respectively. Among survivors, interim angiographic evaluation was performed in 128 patients at a mean follow-up of 52.4 +/- 13.5 months, and the patency rate of the LITA-LAD anastomosis was 91.4%.
Conclusions: Patients with diffuse LAD disease present a major challenge for cardiovascular surgeons. The long-term results of long-segmental LAD reconstruction are very encouraging, and this approach may be used safely in this subgroup of patients.